Transbronchial biopsy as a tool to evaluate small-airways disease in asthma. Cons
European Respiratory Society
Regional Professional Studies
Regional Professional Studies CHS
Recently, there has been renewed interest in the importance of the small airways (internal perimeter <6 >mm) in asthma 1. This was initiated largely by the observation that the use of the inhaled corticosteroid beclomethasone as a small-particle formulation, with greater penetration to the peripheral lung, results in similar improvements in symptoms and lung function at half the delivered dose of standard formulations of beclomethasone 2. The structure of the small airways is altered in asthma, even in mild cases 3, and structural changes in the small airways will theoretically lead to greater alterations in airway mechanics than similar changes in the central airways 4. Therefore, it seems desirable to find a way to safely assess the pathology of small airways in asthma. Transbronchial biopsy (TBB) is not the way to do it, at least not yet.